Pre-Certification Required for FEP Member Inpatient Stay

  • December 16, 2021

    Starting January 1, 2022, pre-certification will be required for inpatient stays for all Blue Cross and Blue Shield Federal Employee Program (FEP) members.

    How to Pre-Certify:

    If the FEP member is not pre-certified for an inpatient stay and:

    • The inpatient level of care is determined as medically necessary: payments for the inpatient hospital stay are reduced by $500.
    • The inpatient level of care is determined as not medically necessary: FEP will not provide benefits for inpatient room and board or inpatient physician care.
    • The service associated with the admission is determined as not medically necessary, or is experimental/investigational,or not a covered service: all charges will be denied.
    Learn more details in the FEP Standard and Basic Option brochure or the FEP Blue Focus brochure

     

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